Provider Demographics
NPI:1215418496
Name:BLACK-SINGLETARY, MONIQUE E (PT)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:E
Last Name:BLACK-SINGLETARY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 PETERFORD DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-9313
Mailing Address - Country:US
Mailing Address - Phone:336-375-3651
Mailing Address - Fax:
Practice Address - Street 1:7900 TRIAD CENTER DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409-9073
Practice Address - Country:US
Practice Address - Phone:336-668-4558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9352208100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation